The IHI VAP preventive Bundle seems to be a veryuseful tool in VAP reduction, combined with adequate ETT cuff pressure and subglotticsuctioning, without forgetting the hand hygiene and aseptic suctioning technique. ICUsshould adopt basic practices that prevent or decrease VAP rates, and as a result, mortality,duration of mechanical ventilation, length of stay, and healthcare costs. Moreover, thestrategies should be multifaceted and supported by a long-term education program byensuring compliance in the care bundle

We assume thatmeasures such as hand hygiene and aseptic suctioning technique are of the most basictechniques and that they were taken for granted, along with all the other interventionsfor VAP prevention in the included studies

most of the studies involved oral hygiene in their bundles. Oralcare remains an important tool for dental plaque removal and the promotion of a normalmicrobial community inside the oral cavity, thus preventing the growth of microorganismsin the trachea and the creation of VAP

Education program included self-learning packets, presenta-tions, discussions, knowledge questionnaires, posters, checklists, videos, reminder signs inpatients’ rooms, nursing and medical champions, stimulation scenarios and feedback meet-ings.

The studies with the highest rate of reduction [ 5, 19,25 ] implemented the “IHI Ventila-tor Bundle” combined with adequate ETT cuff pressure at 20–30 cm H2O and subglotticsuctioning.

The most commonbias in the pre-post observational studies was the bias due to deviations from intendedinterventions

The most common interventions monitored in the care bundles were sedation andweaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease anddeep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bedelevation was implemented by almost all studies, followed by oral hygiene, which was the secondextensively used intervention.